Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Department of Gastroenterology, Fuzhou First People's Hospital, Fuzhou, Jiangxi, China.
Epidemiol Infect. 2021 Jan 5;149:e26. doi: 10.1017/S0950268820003143.
The prediction of prognosis is an important part of management in hepatitis B virus (HBV)-related decompensated cirrhosis patients with high long-term mortality. Lactate is a known predictor of outcome in critically ill patients. The aim of this study was to assess the prognostic value of lactate in HBV-related decompensated cirrhosis patients. We performed a single-centre, observational, retrospective study of 405 HBV-related decompensated cirrhosis patients. Individuals were evaluated within 24 h after admission and the primary outcome was evaluated at 6-months. Multivariable analyses were used to determine whether lactate was independently associated with the prognosis of HBV-related decompensated cirrhosis patients. The area under the ROC (AUROC) was calculated to assess the predictive accuracy compared with existing scores. Serum lactate level was significantly higher in non-surviving patients than in surviving patients. Multivariable analyses demonstrated that lactate was an independent risk factor of 6-months mortality (odds ratio: 2.076, P < 0.001). Receiver operating characteristic (ROC) curves were drawn to evaluate the discriminative ability of lactate for 6-months mortality (AUROC: 0.716, P < 0.001). Based on our patient cohort, the new scores (Model For End-Stage Liver Disease (MELD) + lactate score, Child-Pugh + lactate score) had good accuracy for predicting 6-months mortality (AUROC = 0.769, P < 0.001; AUROC = 0.766, P < 0.001). Additionally, the performance of the new scores was superior to those of existing scores (all P < 0.001). Serum lactate at admission may be useful for predicting 6-months mortality in HBV-related decompensated cirrhosis patients, and the predictive value of the MELD score and Child-Pugh score was improved by adjusting lactate. Serum lactate should be part of the rapid diagnosis and initiation of therapy to improve clinical outcome.
乳酸在乙型肝炎病毒相关失代偿性肝硬化患者中的预后预测价值
预后预测是乙型肝炎病毒（HBV）相关失代偿性肝硬化患者管理的重要组成部分，此类患者长期死亡率较高。乳酸是危重症患者预后的已知预测指标。本研究旨在评估乳酸在 HBV 相关失代偿性肝硬化患者中的预后价值。我们进行了一项单中心、观察性、回顾性研究，纳入了 405 例 HBV 相关失代偿性肝硬化患者。个体在入院后 24 小时内进行评估，主要结局在 6 个月时进行评估。多变量分析用于确定乳酸是否与 HBV 相关失代偿性肝硬化患者的预后独立相关。计算 ROC 曲线下面积（AUROC）以评估与现有评分相比的预测准确性。与存活患者相比，非存活患者的血清乳酸水平显著更高。多变量分析表明，乳酸是 6 个月死亡率的独立危险因素（比值比：2.076，P<0.001）。绘制受试者工作特征（ROC）曲线以评估乳酸对 6 个月死亡率的区分能力（AUROC：0.716，P<0.001）。基于我们的患者队列，新评分（终末期肝病模型（MELD）+乳酸评分、Child-Pugh+乳酸评分）对预测 6 个月死亡率具有良好的准确性（AUROC=0.769，P<0.001；AUROC=0.766，P<0.001）。此外，新评分的性能优于现有评分（均 P<0.001）。入院时的血清乳酸可用于预测 HBV 相关失代偿性肝硬化患者的 6 个月死亡率，通过调整乳酸，可提高 MELD 评分和 Child-Pugh 评分的预测价值。血清乳酸应成为快速诊断和启动治疗以改善临床结局的一部分。
